Scleral Tunnel Incision Research Articles

Rigid Iris-Fixated Phakic Lens Implantation for High Myopia: Novel Trapezoidal Corneal versus Scleral Incisions

To compare refractive performance of implantation of an iris-fixated phakic intraocular lens (PIOL) through a novel trapezoidal corneal and a scleral tunnel incision. Sixty-nine eyes selected to undergo PIOL implantation were randomly assigned to 1 of 2 groups: 5.2-mm trapezoidal corneal incision (TCI), 34 eyes; 5.2-mm scleral tunnel incision (STI), 35 eyes. Visual acuity, refraction, corneal astigmatism, tonometry, and endothelial cell density were recorded preoperatively and postoperatively. Surgically induced astigmatism (SIA) was calculated using vector analysis. No intraoperative complications were noted. One day after surgery, the quantity of cells in the anterior chamber was significantly lower in TCI group than in STI group (p=0.019). The percentage of eyes with uncorrected visual acuity (UCVA) of ≥20/25 was 41.2% for TCI and 17.1% for STI; the difference was statistically significant (p=0.03), but not thereafter. The mean corneal astigmatism was significantly lower in the TCI group than in the STI group (p=0.01) 3 months postoperatively and subsequently. No significant between-group difference in SIA was found during the follow-up. There was no significant difference in best-corrected visual acuity and endothelial cell loss between groups, postoperatively. The TCI and STI techniques are comparable in terms of safety and induction of astigmatism for the rigid iris-fixated PIOL implantation. However, the TCI is easy to perform and provides a faster visual recovery and lower postoperative corneal astigmatism compared with the STI.

Relative factor analysis of macula hole retinal detachment after phacoemulsification cataract extraction combined with intraocular lens implantation

Objective To observe the incidence and related factors of macula hole retinal detachment (MHRD)after phacoemulsification cataract extraction and intraocular lens(IOL) implantation. Methods The clinical data of 10 076 patients (13 625 eyes) who underwent phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed. There are 1228 patients (1853 eyes) with high myopia. All the patients were examined by routine slit-lamp microscopy, ophthalmoscopy as well as A-or B-scan ultrasonography. The phacoemulsification cataract extraction with transparent cornea incision or scleral tunnel incision, combined with intraocular lens implantation was performed in all the patients. The follow-up was ranged from 12 to 126 months, with a mean of (48.2±31.1) months. The MHRD was confirmed by the examinations of the fundus, B-scan ultrasonography and optical coherence tomography.The incidence of postoperative MHRD and the risk factors were analyzed. Results 10/13 625 eyes (0.073%) with MHRD were observed. 7/1853 high myopia eyes (0.378%) with MHRD were observed.The occurrence time of MHRD was ranged from 9 to 74 months after surgery, with a mean of 38.5 months.The cumulative risk was estimated at 0.16% (95% confidence interval, 0.05%-0.27%). Conclusions The incidence of MHRD after phacoemulsification cataract extraction combined with intraocular lens implantation is 0.073%. The MHRD incidence of high myopia eyes is 0.378%. High myopia may be the risk factor for MHRD. Key words: Retinal detachment/etiology; Phacoemulsification; Phakic intraocular lenses

Comparing the astigmatic outcome after paediatric cataract surgery with different incisions

AimsTo compare astigmatism with clear corneal incision versus scleral tunnel incision following paediatric cataract surgery with primary intraocular lens implantation.MethodsRetrospective, comparative case series of 218 eyes of 138 children <12...

Manual small incision cataract extraction through temporal scleral incision after glaucoma surgery

Objective To evaluate the clinical effects of small incision cataract extraction through a temporal scleral incision after glaucoma surgery. Methods 47 eyes of 42 patients with cataract after glaucoma surgery underwent manual small incision catarat extraction through a temporal scleral tunnel incision. The postop-erative visual acuity, IOP, and filtering bleb were observed. Results Follow up 3 - 18 months the visual acuity of all the eyes were improved after surgery. There were no change in IOP and filtering bleb.Postoperative changes in corneal curvature (0. 75～1. 25 D) extraction after 3 months return to preoperative levels. Conclusion The manual small incision cataract extraction throuhg a temporal scleral tunnel incision is convenient and effective in treating cataract after glancoma surgery. Key words: cataract; temporal scleral incision; cataract extraction,small incision; glaucoma

Surgical-induced astigmatism via a 5.5mm superior scleral tunnel incision for implantation of an Artisan phakic intraocular lens

Background Surgical induced astigmatism induced by a 5.5mm of superior scleral tunnel incision is a key cause of influencing vision outcome in the high myopic eyes after implantation of Artisan phakic intraocular lens(IOL).Objective This study was to evaluate the surgical induced astigmatism through a 5.5mm superior scleral tunnel incision during the implantation of Artisan phakic IOL.Methods This was a case observational study.The clinical data of 202 eyes of 111 patients with Artisan IOL implantation for high myopia from October 2004 through October 2008 was collected.The patients were followed-up for 12 months.The uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BCVA),spherical equivalent(SE),cylinder equivalent(CE) and cylinder axis were examined before surgery and postoperative 1,3,6,12 months.The patients were divided into with rule group and against rule group according to the cylinder axis.Surgery-induced astigmatism value was calculated using Holladay vector analysis formula.This clinical trial was approved by the Ethics Committee of Guangdong General Hospital.Written informed consent was obtained from each patient prior to the surgery.Results The UCVA of 195 eyes(94.1%) was 0.5 or better in postoperative 12 months,and that of 172 eyes(85.1%) showed the improvement of BCVA during the follow-up duration.The mean CE values were reduced in 1,3,6,12 months after surgery in comparison with before surgery(t=-4.30,P=0.00;t=-2.27,P=0.01;t=-2.04,P=0.04;t=-2.79,P=0.01).Vector analysis of total surgically induced astigmatism revealed that the mean incision-induced astigmatism value was +1.94D,+2.26D,+2.29D,+2.25D at 171°,170°,181°,175° in 1,3,6,12 months after surgery.The surgery-induced astigmatism was(+1.97±1.84)D,(+2.25±1.75)D,(+2.27±1.76)D,(+2.24±1.75)D in with rule group at postoperative 1,3,6,12 months respectively;while those in against rule group was(+1.75±1.88)D,(+2.35±1.74)D,(+2.38±1.76)D,(+2.34±1.74)D respectively.No significant differences were found between the two groups(t=0.54,-0.29,-0.27,-0.29;P=0.59,0.78,0.79,0.78).Conclusion Implantation of Artisan IOL is an effective approach for correction of high myopia.A 5.5mm superior scleral tunnel incision in operation induces a +2.25D astigmatism at 175° meridian. Key words: Surgical induced astigmatism; Phakic; Intraocular lens; Superior scleral tunnel incision

Visual outcome of manual small-incision cataract surgery: comparison of modified Blumenthal and Ruit techniques.

To compare the efficacy and visual results of the modified Blumenthal and Ruit techniques for manual small-incision cataract surgery (MSICS). This was a prospective, non-randomized comparison of 129 patients with senile cataracts scheduled to undergo routine cataract surgery via either a superior scleral tunnel incision, i.e., the Blumenthal technique (group 1, n=64) or a temporal scleral tunnel incision, i.e., the Ruit technique (group 2, n=65). MSICS and intraocular lens implantation were performed through an unsutured 6.5- to 7.0-mm scleral tunnel incision. Uncorrected and corrected visual acuity, intraoperative and postoperative complications, and surgically induced astigmatism calculated by simple subtraction were compared. Patients were examined at 1 day, 1 week, 1 month, and 3 months after surgery. Both groups achieved good visual outcome with minor complications. Three months after surgery, the corrected visual acuity was 0.73 in the Blumenthal group and 0.69 in the Ruit group (P=0.29). The average (SD) postoperative astigmatism was 0.87 (0.62) diopter (D) for the Blumenthal group and 0.86 (0.62) D for the Ruit group. The mean (SD) surgically induced astigmatism was 0.55 (0.45) D and 0.50 (0.44) D for the Blumenthal and Ruit groups, respectively (P=0.52). Common complications were minimal hyphema and corneal edema. There was no statistically significant difference in the complication rate between the groups (P>0.05). In MSICS, both the Blumenthal and Ruit techniques achieved good visual outcomes, with low complication rates.

Influence of corneoscleral limbus incision on tear film stability after phacoemulsification

目的 探讨角巩膜缘切口对白内障超声乳化术后泪膜变化的影响.方法 研究为临床疗效评价的病例对照研究.收集2006年7月-2008年12月行小切口白内障超声乳化及人工晶状体(IOL)植入术的年龄相关性白内障患者128例219眼;年龄61～87岁,平均年龄(66.1±12.1)岁.按信封法随机将患者分为3组,其中角巩膜缘切口组42例69眼,透明角膜切口组45例70眼,巩膜隧道切口组41例80眼.各组资料的人口统计学特征差异无统计学意义(P>0.05).在术前第1天,术后第1、2、7、30、90天对各组患者进行干眼症状评分、Schirmer试验(SIt)、泪膜破裂时间(BUT)和角膜荧光素染色(FLS)4项指标的检测.结果 角巩膜缘切口组、透明角膜切口组和巩膜隧道切口组在检测的各时间点(F=110.51,P=0.00)干眼症各组临床评分(F=99.45,P=0.01)的差异均有统计学意义.角巩膜缘切口组干眼症临床评分在手术后14d逐渐下降,各时间点的临床评分与术前相比差异均有统计学意义(P 0.05),而透明角膜切口组手术后14d的BUT值最低.手术后1d角巩膜缘切口组的SIt值达高峰,第1～14天逐渐降低,各组间的差异均有统计学意义(P 0.05).结论 角巩膜缘切口对泪膜的稳定性影响小,是干眼症高危患者白内障超声乳化术较为理想的选择。

Extracapsular cataract extraction in sclerotic nucleus cataract through a small incision of improved after glaucoma surgery

Objective To observe the therapeutic effect of extracapsular cataract extraction of Ⅳ/Ⅴ grade sclerotic cataract with IOL implantation after glaucoma trabeculectomy through a small incisions.Methods Eighty-two cases(114 eyes)of Ⅳ/Ⅴ grade sclerotic cataract accepted cataract extraction through an anti-superciliary arch temporal corneal limbus lamellar scleral tunnel incision with IOL implantation after glaucoma trabeculectomy for more than half a year.Follow up 6-12 months.The postoperative vision,IOP,filtrate bleb and complications were observed.Results The postoperative vision were improved in 82 cases(114eyes) ,in which 34 eyes' (29.82%) vision ≥ 0.6,47 eyes' (41.23%) 0.4-0.6,27 eyes' (23.68%) 0.2-0.4,6 eyes'(5.26%) ≤0.2.The postoperative filtrate blebs were well-preserved and the pupils forming effective,41 of the pupils on the move,mydriasis and deformation were improved.The postoperative average IOP was(15.15 ±2.78)mm Hg(1 mm Hg = 0.133 KPa) ,and it was no statistically significant differences in pre-or post-operative intraocular pressure(t'= 0.21 ,P ＞ 0.05).There were 38 eyes with corneal edema and 3 eyes with uveitis after improved surgery.Conclusion This operative technique is effective to treat sclerotic cataract after glaucoma surgery.,which is simple and easy to promote. Key words: Improved operation; Sclerotic nucleus cataract; Glaucoma

Negative dysphotopsia after temporal corneal incisions

Temporal incisions made during cataract extraction have been purported to cause negative dysphotopsia. A case in which negative dysphotopsia occurred after superior scleral tunnel incisions is described. The dystopsia symptoms resolved immediately after intraocular lens exchange using temporal corneal incisions.

Replacement of the Lens and its Capsule that Dislocated to the Anterior Chamber by the Posterior Iris Claw Lens.

In a case with retinitis pigmentosa, the intraocular lens that dislocated to the anterior chamber 20 tears after the cataract surgery has been removed via scleral tunnel incision. Then, the iris claw lens was placed behind the iris again by the scleral tunnel. This case was reported as an example for both its existing and rehabilitation method.

Bilateral intraocular hemorrhage from vascularization of cataract wounds

We report a case of bilateral intraocular hemorrhage from vascularization of cataract wounds. The patient experienced decreased vision following an episode of vomiting more than 2.5 years after phacoemulsification through a scleral tunnel incision in the right eye and combined trabeculectomy and extracapsular cataract extraction in the left eye. Gonioscopy demonstrated abnormal vessels in the region of the cataract wound superiorly and small hyphemas inferiorly in both eyes. The hemorrhages and elevated intraocular pressure normalized over weeks. The left eye had a recurrent hemorrhage 5 months later, which was successfully treated with argon laser goniophotocoagulation.

Application on transfixion needle of disposable infusion apparatus for phacoemulsification

目的 探讨一次性输液器瓶盖穿刺针头在白内障晶状体超声乳化手术中应用的意义.方法 分别应用一次性穿刺刀(A组,70眼)和一次性输液器瓶盖穿刺针头(B组,60眼)做巩膜隧道切口,进行老年性白内障晶状体超声乳化手术.比较手术时间、术后视力、角膜散光情况及并发症.结果 A组巩膜隧道切口时间5～9 s, 白内障晶状体超声乳化吸出手术时间为(180±53)s;B组隧道切口时间6～11 s,手术时间为(185±46)s,两组差异无统计学意义(P＞0.05).术后1d、1周和1月两组的最佳矫正视力差异无统计学意义( P＞0.05),术后1月A、B两组视力1.0以上者分别占82.85%和78.33%.A组术前散光平均为(0.55±0.53)D, 术后 1个月散光为(0.73±0.45)D,与术前比较差异无统计学意义(P＞0.05).B组术前散光平均为(0.65±0.42)D, 1个月散光为(0.80±0.25)D, 与术前比较差异无统计学意义(P＞0.05).两组术中及术后并发症差异无统计学意义( P＞0.05).结论 锋利的一次性输液瓶塞穿刺针头经过简单的改装,可用以做巩膜隧道切口,安全有效,能够有效减少手术成本。

Simple technique for graft insertion in Descemet-stripping (automated) endothelial keratoplasty using a 30-gauge needle

We describe a needle insertion technique for graft insertion in Descemet-stripping (automated) endothelial keratoplasty (DSEK/DSAEK). A folded donor posterior corneal disk is inserted through a 5.0 mm scleral tunnel incision over a plastic glide using a 30-gauge needle. The technique enables safe and easy graft insertion without vertical or horizontal compression of the donor tissue, causing minimal trauma to the donor endothelium and/or host structures.

Comparison of the Keratometric Corneal Astigmatic Power after Phacoemulsification: Clear Temporal Corneal Incision versus Superior Scleral Tunnel Incision

Objective. This is prospective randomized control trial to compare the mean keratometric corneal astigmatism diopter power (not surgical induced astigmatism) among preop and one-month and three-month postop phacoemulcification of either a clear temporal corneal incision or a superior scleral tunnel Incision, using only keratometric astigmatic power reading to evaluate the difference between the two cataract surgery incisions. Methods. 120 patients (134 eyes) underwent phacoemulcification were randomly assigned to two groups: Group A, the clear temporal corneal incision group, and Group B, the superior scleral tunnel incision group. SPSS11.5 Software was used for statistical analysis to compare the postsurgical changes of cornea astigmatism on keratometry. Results. The changes of corneal astigmatic diopter in Groups A and B after 3 month postop from keratometric reading were 1.04 + 0.76 and 0.94 + 0.27, respectively (P = .84 >.05), which showed no statistic significance difference. Conclusion. The incision through either temporal clear cornea or superior scleral tunnel in phacoemulcification shows no statistic difference in astigmatism change on keratometry 3-month postop.

Prophylaxe der postoperativen infektiösen Endophthalmitis durch intrakamerale Cefuroximgabe – auf dem Weg zum Therapiestandard?

Several studies investigating the antibiotic prophylaxis of acute postoperative endophthalmitis provide very different results concerning the incidence and prophylaxis of this very severe complication of cataract surgery. For a long time the preoperative use of povidione-iodine had been the only procedure with overall acceptance and proven benefit. Following findings in Sweden that supported the advantages of the use of intracameral cefuroxime, the European Society of Cataract and Refractive Surgeons (ESCRS) performed a study to confirm the Swedish results and to lead to a revision of ESCRS guidelines. In a randomised, partially masked and placebo-controlled study 16,211 patients undergoing phacoemulsification cataract surgery were included. 25 ophthalmological units in 9 European countries took part in this study. The study consists of a 2 x 2 factorial design, dividing patients into 4 treatment groups. Two out of the 4 groups were treated with 1 mg intracameral cefuroxime (in 0.1 mL isotonic NaCl solution). In parallel, two groups (one treated with cefuroxime, one untreated) received topical levofloxacin 0.5% in a standard regimen. If clinical signs like pain or loss of vision indicated a postoperative endophthalmitis, suspicious results were confirmed by culture, Gram stain and PCR. In a follow-on study, Sundelin (Sweden) and colleagues included 30 patients who received topically-applied levofloxacin 0.5% following the ESCRS dosing scheme, in addition to intracameral administration of cefuroxime. Aqueous humour samples were taken at the end of surgery and at a second time point postoperatively. The levofloxacin concentration was measured by HPLC. The median maximal concentration (Cmax) was compared with the MIC90-values of relevant bacterial isolates. 29 patients developed a postoperative endophthalmitis, of whom 20 were classified as having a proven infectious cause. The absence of a prophylactic intracameral cefuroxime administration at 1 mg in 0.1 mL isotonic NaCl was associated with a 4.92-fold increase in the risk of postoperative endophthalmitis (95% CI 1.87-12.9). A clear corneal incision (CCI) or the use of silicon based IOL optic material accounted as additional risk factors for postoperative endophthalmitis. While the use of CCI was associated with a 5.88-fold higher risk of infection compared to STI (scleral tunnel incision), the implantation of silicon based IOL was associated with a 3.13-fold higher risk. Intraoperative complications were also associated with a higher risk of postoperative endophthalmitis (4.95-fold higher risk). Intracameral injection of cefuroxime reduces the risk of postoperative infectious endophthalmitis following phacoemulsification cataract surgery. Additional risk factors are the use of CCI and silicon based IOL implants.

Prediction of postoperative astigmatism in cataract surgery

Background: The purpose of this study was to predict postoperative astigmatism using refraction, keratometry, and other preoperative information after phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Methods: A retrospective study was conducted of 176 eyes of 161 patients undergoing phacoemulsification for visually significant cataract with capsular bag or sulcus IOL fixation at the Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, Va. Eyes with complications and final-corrected visual acuity of less than 20/60 were excluded. Keratometric and refractive astigmatism were described by Jackson cross-cylinder with-the-rule (J 0) and oblique (J 45) components. Preoperative predictors of postoperative refractive J 0 and J 45 were determined by univariate and multivariate regression analysis. Results: The final multivariate model to predict postoperative with-the-rule astigmatism was J 0Postoperative = 0.24 × J 0Preoperative 0.46 × J 0Keratometic − 0.08 (coefficient of determination [r 2] = 0.51, all p < 0.001). The multivariate model based on expected predictors of oblique astigmatism was J 45Postoperative = 0.10 × J 45Preoperative + 0.23 × J 45Keratometric + 0.01, (r 2 = 0.05, p = 0.09 for J 45Preoperative and 0.03 for J 45Keratometric). Temporal clear cornea (as opposed to superior scleral tunnel) incisions, and use of sutures in scleral tunnel incisions, were not predictive of postoperative astigmatism. Interpretation: Postoperative astigmatism can be estimated from preoperative astigmatism using the following weighted average: two-thirds keratometric and one-third refractive astigmatism. Preoperative refraction may predict postoperative astigmatism independent of keratometry because keratometry reflects only the paracentral anterior (not posterior) corneal curvature.

Secondary Artisan–Verysise intraocular lens implantation for aphakic correction in post-traumatic vitrectomized eye

To evaluate the efficacy and safety of Artisan-Verysise intraocular lens (IOL) secondarily implanted for aphakic correction in post-traumatic vitrectomized eyes. Postoperative outcomes of secondary implantation of an iris-supported Artisan IOL in 17 unilateral aphakic patients with previous pars plana vitrectomy secondary to posterior segment trauma were evaluated prospectively. Eyes had vitrectomized in previous 6-60 months. After complete ophthalmologic examination, IOL implantation was performed through a scleral tunnel incision. Patients were followed for visual outcome, endothelial cell density (ECD) and occurrence of complications. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalents (SE), and ECD were compared before and after IOL insertion. Patients' postoperative mean follow-up were 14.65+/-5.21 months. UCVA improved in all patients. (0.03+/-0.1 preoperatively vs 0.45+/-0.29 postoperatively, P=0.0001). However improvement of BCVA was not significant. Mean postoperative SE was 0.84+/-1.32 D, whereas it was 10.85+/-1.70 D preoperatively (P=0.0001). SE was within +/-2.00 D of emmetropia in 16 eyes (94.1%). Mean endothelial cell loss was 8.1% in first 6 postoperative months.All eyes achieved the desired anatomic results. No intraoperative complications occurred in any of our cases. Complications were transient pigmented precipitates (three cases), choroidal detachment (one case), and transient vitreous haemorrhage (one case). Secondary Artisan IOL implantation is an effective and safe procedure to correct aphakia in vitrectomized eyes without capsular support after trauma. Considering good visual rehabilitation and low rate of complications, this procedure is recommended in vitrectomized eyes.

Sutureless Combined 25-Gauge Vitrectomy, Phacoemulsification, and Posterior Chamber Intraocular Lens Implantation for Management of Uveitic Cataract Associated With Posterior Segment Disease

To report visual outcomes and complication rates associated with one-stage surgery for the management of uveitic cataract associated with posterior segment disease. In this interventional case series, 19 eyes (19 patients) with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens (PC-IOL) implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema, and complications of surgery. After a minimum 12-month follow-up, visual acuity was >or=20/100 in 12 eyes (63.2%); 6 eyes (31.6%) had visual acuity of >or=20/40. A decrease in postoperative inflammatory activity of 1 grade was observed in 8 eyes (42.1%). Sixteen eyes had cystoid macular edema before surgery; and 12 eyes had cystoid macular edema after surgery. Early postoperative complications included the following: transient corneal edema, 10 eyes (50.3%); fibrin reaction, 3 eyes (15.8%), and posterior synechiae, 9 eyes (47.3%). Glaucoma was the most common late postoperative complication (3 eyes [18.8%]). Nine eyes (47.4%) needed YAG laser capsulotomy during the first year. Sutureless combined 25-gauge total vitrectomy, phacoemulsification, and PC-IOL implantation may be well tolerated with an acceptable complication rate for selected uveitic eyes with significant cataract and coexisting posterior segment disease for restoring useful vision.

The surgical treatment for posterior capsule opacification on pseudophakic eyes

目的 探讨巩膜隧道切口插管灌注经睫状体平坦部后囊切开术治疗人工晶状体眼后发性白内障的效果.方法 32例(34眼)人工晶状体植入术后后发性白内障行巩膜隧道切口插管灌注经睫状体平坦部后囊切开术.平均随访18个月.结果 全部术眼晶状体后囊中央均形成直径3.5-4 mm的圆形透明区,后发性白内障切开术的成功率为100%;术中前房稳定,人工晶状体无损伤.术后能配合视力检查的患者最佳矫正视力均恢复至后发性白内障发生前的最佳水平;随访期间无切口渗漏、角膜水肿、瞳孔区玻璃体疝、人工晶状体损伤、视网膜脱离、高眼压或晶状体后囊膜切开区再次浑浊等并发症.结论 巩膜隧道切口插管灌注经睫状体平坦部后囊切除术治疗人工晶状体植入术后的后发性白内障安全、有效。

Cataract surgery and anterior megalophthalmos: Custom intraocular lens and special considerations

We report a patient who presented with anterior megalophthalmos: corneal diameter of nearly 17.0 mm, anterior chamber depth of 7.0 mm, mild lens subluxation, and nuclear sclerotic cataract. Surgical management consisted of a scleral tunnel incision, capsule staining, a predetermined capsulorhexis size, microcoaxial phacoemulsification with torsional ultrasound, and implantation of a custom IOL to ensure endocapsular fixation. Special consideration must be given to the patient with a very large anterior segment.